1. When you joined as Health Minister, why did you continue your presidency in Delhi Medical Association?

A: The media too asked me at that time since I was the Health Minister of Delhi, why should I continue my position in DMA? My answer was that as a Health Minister, I am answerable to the public and as DMA President, I am answerable also to my professional colleagues.

2. What was the controversy between Polio Kendra and Polio Booth when you started the Polio programme?

A: Some of my opponents wanted to call the programme Polio Booth and not Polio Kendra because they thought that Polio Programme was a political campaign but it was not.

3. Why has quackery not been eradicated from the city so far?

A: I tried my level best and even tabled the Anti-quackery Bill but it could not be passed as our government changed. If I come back to power, we will revive the file. Also, do remember that quacks are better organized than medical professionals.

4. What are you views about Delhi Medical Association completing its 100 years?

A: Delhi Medical Association is the mother of Indian Medical Association. DMA will observe its 100th year this year and IMA will be doing it 14 years later. DMA should think big this year. All chapters of DMA should sit together and plan something big.

5. Should DMA be free of alcohol and tobacco?

A: It was when I was President of DMA.

6. What about black sheep in medical profession?

A: They need to be identified and punished. Doctors are role models for the society and if they think that they are the cream of the society, they should act accordingly.

7. Do you feel doctors are rated past amongst IAS?

A: No. A BA pass can also become an IAS but it is the cream of society, which chooses to become doctors and scientists. So, doctors have no reason to feel inferior to the IAS officers.

8. How can the image of medical profession be improved?

A: One should remember that who is speaking is not important but it is what he is speaking that is important. I have not forgotten the mantra I received from my school teacher, Dr. J.P. Sharma and I still follow that and the mantra is – “Honesty is the only ladder which can help a man climb the heightened height of ecstatic pleasure from the lower field of abject fortunes.”

Honesty, dedication and focused commitment are the answer. The doctor should also project to the society that they are sacrificing their years of life for the care of the public. Doctors die earlier than non-doctors by at least 10 years. It is evident from the fact that out of 100 only 28 DMA presidents are alive.

Over 11459 people were trained in Hands Only Cardiopulmonary Resuscitation (CPR 10) in one day

National News

MCI asks all medical institutions to be ‘accessible’

The Hindu: With not a single medical institution in India being completely accessible for persons with disabilities due to physical barriers in libraries, lecture halls and hospital campus, the Medical Council of India has now issued directions to the Deans/Principals of all the medical colleges/institutions in India to submit compliance report on access facilities for persons with disabilities directly to the office of the Chief Commissioner for Persons with Disabilities (CCPD).

The MCI issued the notice on a petition by Dr. Satendra Singh, Coordinator with the Enabling Unit of the Equal Opportunity Cell of the University College of Medical Sciences, here.

Dr. Singh had made a representation to CCPD to include ‘access audits’ in all inspections by the MCI and to derecognise all such hospitals that fail this test.

He had also submitted that while the MCI ensured reservation for persons with lower limbs extremities of 50 per cent to 70 per cent, for admission in all the medical courses, a number of medical institutions were completely inaccessible.

Dr. Singh, who himself suffers from “locomotor impairment” had remarked that “people with impairments are made disabled by the insensitive medical institutes and hospitals”. He had stated that while the MCI follows strict compliance in assessing building dimensions during inspections, but nowhere efforts are made to see whether the college is accessible to students with disabilities. He had noted that there was thus a need to make these buildings fully accessible to persons with disabilities.

The Chief Commissioner’s officer had subsequently issued a notice to the MCI in January this year to submit the action taken report. When nothing happened in the stipulated one month, another strong reminder was sent and the MCI was asked to respond before April 10.

The MCI then issued a directive to the Deans/Principals of all the medical colleges and institutions on March 29 to submit compliance report on access facilities for persons with disabilities directly to CCPD.

But Dr. Singh insists in doing so. “The MCI response is also shying away from responsibility.” He charged that “no mandatory directives were passed on including ‘access audits’ in inspections and no directive was passed in including medical persons with disabilities in such inspections which I specifically asked for.”

Apprehensive that the MCI was actually trying to skirt the whole issue, Dr. Singh said, “rather than replying to CCPD itself, the MCI has asked the institutions to respond directly to CCPD, Ministry of Social Justice and Empowerment.”

“Persons with disabilities are the world’s largest minority. New World report says one in seven people suffer from some form of disability. Article 9 of the United Nations’ Convention on the Rights of the Persons with Disabilities (UNCRPD) and Section 46 of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, makes it obligatory for India to implement ‘reasonable accommodation’,” he insisted.

Dr. Singh said while he was only “asking institutions to use the Universal Design (the design of all products and environments to be usable by people of all ages and abilities, to the greatest extent possible),” still the matter was not being handled in the right manner by the authorities.

“A ramp will not only be used by a disabled but also by an 80 year old elderly, pregnant women, small children and trolley workers,” he pointed out, adding that “it is my dream to make all the health services in India barrier-free and this is a small effort in that direction.”

The differential diagnosis includes other types of genital injury, infection, dermatologic conditions, congenital conditions affecting the perineum, and conditions affecting the urethra or anus.

Valvular Heart Disease Update

What is the indication of surgery in a valve patient with atrial fibrillation?

Atrial fibrillation is not an absolute indication for surgery in an asymptomatic patient with preserved left ventricular function but the burden of this arrhythmia in a patient with borderline left ventricular function (LVEF 55–60%) may be considered as an indication for surgery, especially if the risk of surgery is low and the valve appears to be amenable to repair.

Prostatic artery embolization could provide a new treatment option for men with benign prostatic hyperplasia (BPH), early results from the first prospective U.S. trial suggested. (Source: Medpage Today)

Patients who report clear symptoms of hypoglycemia but have no blood glucose readings can be classified as having "probable symptomatic hypoglycemia," according to a new task force report from two specialty groups. The updated hypoglycemia classification should foster more accurate reporting in clinical trials, John Anderson, MD, president of medicine and science for the American Diabetes Association (ADA). (Source: Medpage Today)

Lower-dose submicron particle diclofenac offered good pain control compared with placebo, making it a promising therapeutic option for acute pain, researchers reported at the American Academy of Pain Medicine meeting. (Source: Medpage Today)

@DrKKAggarwal: Does the money charged by hospital from their consultants for providing consultancy come under service tax?... http://fb.me/As2Iowrd

@DeepakChopra: We have a great line up for @SagesScientists conference this year. Do join us if you have time, ability, or desire http://www.choprafoundation.org

Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Durga killing Mahishasura

Goddess Durga killed the King of demons, Mahishasura using all her feminine powers described with Durga. The word ‘Mahish’ mean a king (also buffalo) and ‘asura’ means the one who has conquered negative qualities.

Contraceptive agents are usually divided into those that are either hormonal or non hormonal. Most of the hormonal contraceptives work by changing a woman's hormone levels to mimic a pregnancy, therefore preventing eggs from being able to be released from the ovary. In contrast, non hormonal contraceptive agents or devices work by preventing a man's sperm from joining a woman's egg.

Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Safe blood products, used correctly, can be life saving. However, even where quality standards are very high, transfusion carries some risks. If standards are poor or inconsistent, transfusion may be extremely risky.

An Inspirational Story

A Scorpion Moment

There was a man who saw a scorpion floundering around in the water. He decided to save it by stretching out his finger, but the scorpion stung him. The man still tried to get the scorpion out of the water, but the scorpion stung him again.

A man nearby told him to stop saving the scorpion that kept stinging him.

But the man said: "It is the nature of the scorpion to sting. It is my nature to love. Why should I give up my nature to love just because it is the nature of the scorpion to sting?"

Don't give up loving. Don't give up your goodness, even if people around you sting.

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

A pregnant woman develops rabies. What should be done?

The rabies virus is not known to cross placental barrier, and so if the mother develops rabies, the fetus is safe. Hence, the pregnant woman with rabies should be clinically managed and if induction of pregnancy or cesarean section is possible, the obstetrician should do it with some “personal precautions” and immunoprophylaxis (usually three doses of modern vaccine or if there is any accidental exposure, then full course of post-exposure vaccination either by IM or ID route should be given to the obstetrician.) Later the newborn may be given a full course of rabies PEP vaccination.

IJCP Special

Dr Good Dr Bad

Situation: A diabetic with A1c 6% had a BP of 130/88 mmHg. Dr Bad: This is very good control of diabetes. Dr Good: This is very good control but we also need to control your BP. Lesson: Cardiovascular morbidity can only be reduced with aggressive management of hypertension, cholesterol (LDL <100 mg/dL) and aspirin (75–150 mg/day) in patients with or at high risk for cardiovascular disease.

Make Sure

Situation: A patient with fever and cough develops complications after he was given antibiotics. Reaction: Oh my God! What was the need of giving the antibiotics? Lesson: Make sure a patient with fever and cough is not given antibiotics as presence of cough is mostly due to viral infection.

Quote of the Day (Dr GM Singh)

The Grand essentials of happiness are: something to do, something to love, and something to hope for. Allan K. Chalmer

Mind Teaser

Read this…………………

When caring for children who are sick, who have sustained traumas, or who are suffering from nutritional inadequacies, Nurse Ron should know the correct hemoglobin (Hb) values for children. Which of the following ranges would be inaccurate?

Yesterday’s Mind Teaser: Dr. Smith suspects tracheoesophageal fistula in a 1-day-old neonate. Which nursing intervention is most appropriate for this child?

a. Avoiding suctioning unless cyanosis occurs
b. Elevating the neonate’s head and giving nothing by mouth
c. Elevating the neonate’s head for 1 hour after feeding
d. Giving the neonate only glucose water for the first 24 hours

Answer for Yesterday’s Mind Teaser: b. Elevating the neonate’s head and giving nothing by mouth

Doctors should abstain from engaging in research projects involving human subjects unless they are satisfied that the hazards involved are believed to be predictable. Doctors should cease any investigation if the hazards are found to outweigh the potential benefits.

In publication of the results of his or research, the doctor is obliged to preserve the accuracy of the results. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.

In any research on human beings, each potential subject must be adequately informed of the aims, methods, anticipated benefits and potential hazards of the study and the discomfort, it may entail. He or she should be informed that he or she is at liberty to abstain from participation in the study and that he or she is free to withdraw his or her consent to participation at any time. The doctor should then obtain the subject’s freely given informed consent, preferably in writing.

When obtaining informed consent for the research project the doctor should be particularly cautious if the subject is in a dependent relationship to him or her or may consent under duress. In that case the informed consent should be obtained by a doctor who is not engaged in the investigation and who is completely independent of this official relationship.

In case of legal incompetence, informed consent should be obtained from the legal guardian in accordance with national legislation. Where physical or mental incapacity makes it impossible to obtain informed consent, or when the subject is a minor, permission from the responsible relative replaces that of the subject in accordance with national legislation.

The research protocol should always contain a statement of the ethical consideration involved and should indicate that the principles enunciated in the present Declaration are complied with.

Autopsy studies of young people who died in accidents have shown that by the late teens, the heart blockages, the kind of lesions cause heart attacks and strokes are in the process of developing, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Quoting a study published in the journal Circulation, Dr Aggarwal said that it is never too early to start protective measures against heart disease.

The best opportunity to prevent heart disease is to look at children and adolescents and start the preventive process early. More than a third of children and adolescents are overweight or obese.

The first signs that men are at higher risk of heart diseases than women appear during the adolescent years despite the fact that boys lose fat and gain muscle in adolescence, while girls add body fat.

Between the ages of 11 and 19, levels of triglycerides, a type of blood fat associated with cardiovascular disease, increases in the boys and drops in the girls. Levels of HDL cholesterol, the "good" kind that helps keep arteries clear, go down in boys but rise in girls.

Blood pressure increases in both, but significantly more in boys. And insulin resistance, a marker of cardiovascular risk, which is lower in boys at age 11, rise until the 19.

Any protection that the young women have for cardiovascular protection can be wiped out by obesity and hence obesity in girls at any cost should be handled on priority.